Ophthalmic health care in diabetes mellitus: a cross-sectional study in northern Sweden

Abstract

The purpose of this study was to estimate the prevalence of diabetic retinopathy, visual impairment/blindness and previous surgical eye treatments in patients with older-onset vs. younger-onset diabetes mellitus. A cross-sectional study of patients with diabetes mellitus in the area of Umeå, Sweden (135,000 inhabitants) was performed during 1994-1995, comprising 1,805 diabetic patients. Diabetic patients of younger ages were referred more frequently than older for fundus examination. With age at diagnosis <30 years retinopathy was seen in 68% of the patients; with age at diagnosis 30 years or older retinopathy was seen in 66% of the insulin-treated, 30% of the oral agent-treated and 7% of the diet-treated patients. Retinopathy that had previously been treated or needed treatment was seen in about one-third of the patients in both the younger-onset and the insulin-treated older-onset groups. The corresponding values for the oral agent-treated and diet-treated older-onset diabetic patients were 9.4% and 0.6%, respectively. No older-onset diabetic patient with acceptable glycemic control and with only dietary treatment had received or needed ophthalmic treatment. In the Umeå area, patients with a relatively short duration of diabetes had a lower prevalence of diabetic retinopathy than that found in Wisconsin in 1979-1980. We conclude that demand for ophthalmic care in general is much higher for older-onset diabetic patients because of the greater number of patients with older-onset than younger-onset diabetes. In addition, older-onset patients should be examined regularly for treatable retinopathy. Diet-treated older-onset diabetic patients with acceptable glycemic control need little ophthalmic screening.